Provider Demographics
NPI:1225089618
Name:KLETT, TIM VARNUM (LCSW, LISW-S)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:VARNUM
Last Name:KLETT
Suffix:
Gender:M
Credentials:LCSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1659 SOUTH BREIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-6705
Mailing Address - Country:US
Mailing Address - Phone:513-424-0921
Mailing Address - Fax:513-424-4810
Practice Address - Street 1:1659 SOUTH BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-6705
Practice Address - Country:US
Practice Address - Phone:513-424-0921
Practice Address - Fax:513-424-4810
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 00080931041C0700X
KY16111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical